IntroductionSince 2008, severe cases of emerging human adenovirus type 55 (HAdV-55) in immunocompetent adults have been reported sporadically in China. The clinical features and outcome of the most critically ill patients with severe acute respiratory distress syndrome (ARDS) caused by HAdV-55 requiring invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO) are lacking.MethodsA prospective single-center observational study for pneumonia with ARDS in immunocompetent adults admitted to our respiratory intensive care unit (ICU) was conducted. Clinical, laboratory, radiological characteristics, sequential tests of viral load in respiratory tract and blood, treatment, and outcome were prospectively collected and analyzed.ResultsA total of five consecutive patients with severe ADRS confirmed with HAdV-55 infection were included. All five patients were immunocompetent young men, with a median age of 32. Mean time from onset to dyspnea was 5 days. Arterial blood gas analysis at ICU admission revealed profound hypoxia with a mean partial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) of 58.1. Mean length from onset to a single-lobe consolidation showed on chest x-ray (CXR) and, from the first positive CXR to bilateral multilobar lung infiltrates, was 2 days and 4.8 days, respectively. The viral load was higher than 1¿×¿108 copies in three patients, and was 1¿×¿104 in one patient. It was negative in the only patient who survived. The mean length for noninvasive positive pressure ventilation (NPPV) failure and IMV failure were 30.8 hours and 6.2 days, respectively. Four patients received venovenous ECMO. Four out of five (80%) of the patients died despite appropriate respiratory support.ConclusionsHAdV-55 may cause severe ARDS in immunocompetent young men. Persistent high fever, dyspnea, and rapid progression to respiratory failure within 2 weeks, together with bilateral consolidations and infiltrates, are the most frequent clinical manifestations of HAdV-55-induced severe ARDS. Viral load monitoring may help predict patients¿ severity and outcome. NPPV and IMV failure rate were very high, and ECMO may be the choice of respiratory support.Trial registrationClinicaltrials.gov NCT01585922. Registered 20 April 2012.

Attention Score in Context

This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 January 2017.

All research outputs

#3,453,619

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#2,250

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#57,080

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Outputs of similar age from Critical Care

#69

of 116 outputs

Altmetric has tracked 12,182,602 research outputs across all sources so far. This one has received more attention than most of these and is in the 71st percentile.

So far Altmetric has tracked 3,916 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 13.9. This one is in the 42nd percentile – i.e., 42% of its peers scored the same or lower than it.

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